Background

1. Implementing a patient-initiated clinic for people with rheumatoid arthritis: a qualitative evaluation. Victoria Goodwin1, Sue Child1, Mark Perry2, Christian Gericke3, Richard Byng11NIHR CLAHRC for the South West Peninsula2Plymouth Hospitals NHS Trust, 3The Wesley Research Institute, Brisbane, Australia • Aim To explore the experiences of patients and staff of a DA system to understand the process of implementation. Methods • Observation of patient education sessions • Semi-structured interviews with patients (n=23) and staff (n=7) • Thematic analysis identified four key themes. Patients Staff “the feedback I’ve had has been mainly extremely positive and in most cases they are delighted with the service…” “I trust [the nurse], I’ve known her a long, long time and I trust her implicitly.” Building patient confidence “..I’ve got to catch 2 buses which takes about an hour and a half to see a consultant for about 5 minutes, which in my estimation, is a complete waste of time unless something is wrong with me.” “..a great concept for patients who have stable rheumatoid who’ve got a specific disease related problem are able to ring up and get an appointment sorted out very quickly...I think that works really, really well and that’s what it’s designed for” Right place, right time “...I’ve had some who have admitted their disease has got worse but have done nothing about it and some of these patients now I feel shouldn’t have gone into DA.” “I don’t say it’s good for everyone because some people do get very confused you know about different things.” Safety The everyday challenges of managing change “I’m getting more direct access patients and they come with more active, complex problems perhaps more than one problem. I am realising that a 15 minute routine follow-up slot perhaps isn’t long enough to address all the issues.” “..I was a bit nervous really thinking oh if I’m not going to get to see somebody regularly...” • Conclusions: • Direct Access for people with RA: • Increases patient autonomy and is a more person-centred approach • Is not appropriate for everyone • May be a suitable system for the secondary care follow-up of people with other long term conditions. This research was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula at the Royal Devon and Exeter NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Background Rheumatoid Arthritis (RA) is a long term condition causing unpredictable episodes of pain and disability. Management of RA in secondary care is traditionally undertaken by regular clinician-driven reviews. These are often when the patient is well. Conversely if the patient experiences a disease flare-up they may be unable to see a specialist for many months. This results in a mismatch between clinical need and input. Based on previous research findings, a patient-initiated review system called Direct Access (DA) was implemented for people with RA by Plymouth Hospitals NHS Trust. This involved an education session for patients about the new system, a telephone helpline and access to a specialist review within 10 working days.